Gliederung

Objective: The endoscopic neurolysis of the ulnar nerve in the cubital tunnel as a relatively new approach is a less invasive procedure compared to subcutaneus or intramuscular anterior transposition and has shown comparable success rates. Main advantages of this procedure are the small incision technique with comparable length of decompression (with less risk of dissecting the nerve) and less postoperative pain. In this study we present the preoperative status, the intraoperative findings and postoperative outcome of 16 patients who had an endoscopic decompression of the ulnar nerve (from January 2005 to November 2006).

Methods: Endoscopic approach to release the ulnar nerve in the cubital tunnel (all instruments Hoffmann, Karl Storz) was performed on 16 patients aged 26 to 66 (47.8 y), one patient was operated on both sides. Clinical indications were hypesthesia, weakness or palsy of the ulnar nerve innervated muscles and a pathological motor nerve conduction velocity. The postoperative follow-up was performed between one and eighteen months after surgery with a mean 9 months.

Results: After a 15 - 20 mm skin incision above the retrocondylar groove and the identification of the ulnar nerve the tunnel was opened and dilated with a speculum. With the endoscope (30Â° optics) and the dissector, the neurolysis of the ulnar nerve was done under direct vision within the cubital tunnel into distal and proximal direction. No complications related to the operative approach in the 16 patients were seen; a good to optimal postoperative outcome was observed in 15 of 16 patients with improvement of preoperative neurological sings. One patient suffered postoperatively from unrelated epicondylitis and depression and was not satisfied with the postoperative result despite complete normalization of neurophysiological findings.

Conclusions: The endoscopic approach to release the ulnar nerve is a valuable alternative to subcutaneus or intramuscular anterior transposition. It is a save and atraumatic technique with a good postoperative outcome and less postoperative pain. It represents the procedure of choice – for us.